Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Surgery, Hitachi, Ltd, Hitachinaka General Hospital, Ibaraki, Japan.
Int J Clin Oncol. 2023 Jun;28(6):748-755. doi: 10.1007/s10147-023-02328-8. Epub 2023 Mar 16.
Although the transmediastinal approach as a radical esophagectomy for esophageal carcinoma patients has attracted attention, its advantages over the transthoracic approach remain unclear. This study aimed to evaluate the efficacy of transmediastinal esophagectomy (TME) in terms of postoperative respiratory complications compared to that of open transthoracic esophagectomy (TTE).
We reviewed patients with thoracic and abdominal esophageal carcinoma who underwent TME or TTE between February 2014 and November 2021. We compared postoperative respiratory complications as the primary outcome. The secondary outcomes included perioperative operation time, blood loss, postoperative complications, and the number of harvested mediastinal lymph nodes.
Overall, 60 and 54 patients underwent TME and TTE, respectively. The baseline characteristics were similar between the two groups, except for age and histological type. There were no intraoperative lethal complications in either group. The incidence of respiratory complications was significantly lower in the TME group than in the TTE group (6.7 vs. 22.2%, p = 0.03). The TME group had a shorter operation time (403 vs. 451 min, p < 0.01), less blood loss (107 vs. 253 mL, p < 0.01), and slightly higher anastomotic leakage (11.7 vs. 5.6%, p = 0.33). The number of harvested lymph nodes was similar in both groups (24 vs. 26, p = 0.10). Multivariate analysis revealed that TME is an independent factor in reducing respiratory complications (odds ratio = 0.27, p = 0.04).
TME for esophageal carcinoma was performed safely. TME was superior to TTE in terms of postoperative respiratory complications; however, the relatively higher frequency of anastomotic leakage should be considered and requires further evaluation.
虽然经胸纵隔入路作为食管癌根治术已引起关注，但与经胸入路相比，其优势尚不清楚。本研究旨在评估经胸纵隔食管癌切除术（TME）在术后呼吸并发症方面的疗效，与开放性经胸食管癌切除术（TTE）相比。
我们回顾了 2014 年 2 月至 2021 年 11 月期间接受 TME 或 TTE 的胸腹部食管癌患者。我们比较了术后呼吸并发症作为主要结果。次要结果包括围手术期手术时间、出血量、术后并发症和采集的纵隔淋巴结数量。
总体而言，有 60 例和 54 例患者分别接受了 TME 和 TTE。两组患者的基线特征相似，除了年龄和组织学类型。两组均无术中致死性并发症。TME 组的呼吸并发症发生率明显低于 TTE 组（6.7%比 22.2%，p=0.03）。TME 组手术时间更短（403 分钟比 451 分钟，p<0.01），出血量更少（107 毫升比 253 毫升，p<0.01），吻合口漏发生率略高（11.7%比 5.6%，p=0.33）。两组采集的淋巴结数量相似（24 个比 26 个，p=0.10）。多变量分析显示，TME 是降低呼吸并发症的独立因素（比值比=0.27，p=0.04）。
TME 治疗食管癌是安全的。TME 在术后呼吸并发症方面优于 TTE，但吻合口漏的发生率较高，需要进一步评估。
